A Circumcision is an operation to remove the foreskin.
Why is a circumcision required?
There are a number of reasons for doing this operation. These include:
- Cultural or Religious reasons
- Disease of the foreskin preventing it from retracting (such as a condition called Balanitis Xerotica Obliterans (BXO))
- Recurrent infections behind the foreskin (Balanitis)
- Paraphimosis ( a condition where the foreskin is pulled back and gets stuck. It can be very painful.)
- For treating a congenitally abnormal foreskin (Such as hypospadias).
- To prevent infections in a boy with an abnormal urinary tract.
How is a Circumcision performed?
There are a number of ways that Circumcisions are done. In younger children who are having it done for religious or cultural reasons a Plastibel Technique may be used. For older children, or children having it done for medical reasons Formal Circumcision Surgery would be normal.
For this technique local anaesthetic is injected around the penis. The foreskin is opened to allow a Plastibel ring to be places. This is secured with a suture on the outside of the foreskin. Over the course of a week the foreskin falls off.
How is Formal Circumcision Surgery Performed?
Formal Circumcision Surgery is usually done as a day case procedure - meaning that you come in and go home on the same day.
Occasionally there may be a surgical or anaesthetic reason to recommend an overnight stay. This will be discussed with you at the time of surgery
The operation is done with the patient asleep under a Full General Anaesthetic.
As well as the general anaesthetic the patient will have local anaesthetic for pain relief which will work after the surgery has finished. The local anaesthetic may be injected around the base of the penis (penile block) or may be injected into the patients back. This is called a Caudal Block, and is a very effective method of pain relief after the Circumcision Surgery.
The surgery involves removing the foreskin.
At the end of the operation the skin is closed with stitches that you can see. These stitches will dissolve, so there are NO stitches to be taken out.
We put ointment over the tip of the penis, mainly to stop it sticking to your son’s underwear or nappies.
How Long will the Surgery Take?
The circumcision surgery usually takes about 20 - 30 minutes if it is uncomplicated.
This does not include the time for the anaesthetic or recovery after the anaesthetic.
What Happens after the operation?
After the operation your son will wake up and be able to have something to eat and drink straight away. Most children who have this operation go home the same day. This may not be possible if your son is very young, has other medical problems or something unexpected happened during the operation.
It is not uncommon for children to feel a bit sick for the first 24 hours after an anaesthetic. You should encourage your son to drink lots of fluid. As long as he is drinking it does not matter if he is off his food for a day or two.
After the operation the tip of the penis (the Glans) will ‘crust’ over. This is a normal part of healing following circumcision. You should apply ointment such as vaseline over the tip of the penis. This will stop it sticking to underwear / nappies.
Give your son regular pain relief for the first couple of days after the operation. Giving pain killers regularly is much more effective that waiting for someone to complain of pain before giving them something.
If your son had Circumcision Surgery for Balanitis Xerotica Obliterans, you will be given steroid ointment to apply to the tip of the penis twice a day starting after 2 weeks from the surgery. This is to treat the BXO, especially if it is affecting the glans of the penis.
Are there any risks to the surgery?
All operations carry a risk of complications. The potential complications of a circumcision include:
- BLEEDING - if this occurs often it can be treated by applying pressure around the penis. Rarely you need a second operation to stop the bleeding.
- INFECTION - If this occurs it may need to be treated with antibiotics
- COSMESIS - Sometimes people do not like the cosmetic result following a circumcision.
- NARROWING OF THE PEE TUBE - This is most commonly seen after a circumcision is done for Balanitis Xerotica Obliterans (BXO). In these cases it is not the surgery that has caused the narrowing, but the disease itself. Another procedure, such as a meatotomy, may be required to treat this problem.
Following surgery you should call the ward or your family doctor (GP) if:
- Your child is in a lot of pain and pain relief does not seem to help
- Your child has a high temperature and paracetamol does not bring it down
- Your child is unable to pee
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